Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men

Abstract

Background HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals. Methods We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008–2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and Hepatitis C infection. Results The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (<500 copies/ml). The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 (hazard ratio [HR] 1.25, 95% CI 1.09–1.44) and ≥30 drinks per month (HR, 1.30, 95% CI 1.14–1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score ≥5 (HR, 1.19, 95% CI 1.07–1.32) and ≥70 drinks per month (HR 1.13, 95% CI 1.00–1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5–7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals. Conclusions Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals.

Alcohol Use Disorders Identification Test (AUDIT) and mortality risk: a systematic review and meta-analysis

“…Nevertheless, results of this study were in agreement with the overall association found. It should be noted that, although not included in our meta-analysis because it was a cohort with a severe disease, Justice et al 22 showed that among US Veterans, the risk curve for all-cause mortality predicted by the AUDIT-C was much steeper among patients with HIV compared with non-HIV-positive Veterans.…”

Psychosocial complications of HIV/AIDS-metabolic disorder comorbidities among patients in a rural area of southeastern United States

“…Alcohol use is also associated with ART non-adherence and preventable mortality among PLWH (Braithwaite & Bryant, 2010). Even modest alcohol use has adverse impacts on HIV-related health outcomes independent of ART adherence (Justice et al, 2016). Likewise, drinking increases the risk of developing diabetes in persons with comorbid hypercholesterolemia (i.e., elevated levels of cholesterol) (Holbrook et al, 1990).…”

Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence

“…In addition to older age, HIV-associated inflammation, frailty, and substance use (i.e. tobacco, alcohol, and other drugs) (Justice et al, 2016; Crothers et al, 2005; Brothers & Rockwood, 2014) contribute to a greater number of comorbidities complicating the management of HIV infection. Treatment guidelines, developed for people with one disease, but applied to people with multiple chronic conditions can lead to the prescription of multiple concomitant medications, often termed “polypharmacy,” resulting in a significant daily medication burden (Edelman et al, 2013; Moore, Mao, & Oramasionwu, 2015).…”